Hajjar Nicole, Ting Joseph Y, Shah Prakesh S, Lee Kyong-Soon, Dunn Michael S, Srigley Jocelyn A, Khurshid Faiza
Department of Pediatrics, Queen's University, Kingston, Ontario, Canada.
Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
Paediatr Child Health. 2023 Mar 15;28(3):166-171. doi: 10.1093/pch/pxac112. eCollection 2023 Jun.
Sepsis is the leading cause of mortality and morbidity in neonates. Blood cultures are the gold standard in diagnosing neonatal sepsis; however, there are currently no consensus guidelines for blood culture collection in neonates and significant practice variation exists in Neonatal Intensive Care Units (NICUs) globally.
To examine current practices in obtaining blood cultures in the evaluation of neonatal sepsis in NICUs across Canada.
A nine-item electronic survey was sent to each of the 29 level-3 NICUs in Canada, which are equipped to provide highly specialized care for newborns.
Responses were received from 90% (26/29) of sites. Sixty-five percent (17/26) of sites have blood culture collection guidelines for the investigation of neonatal sepsis. Forty-eight percent (12/25) of sites routinely target 1.0 mL per culture bottle. In late-onset sepsis (LOS), 58% (15/26) of sites process one aerobic culture bottle, whereas four sites routinely add anaerobic culture bottles. In early-onset sepsis (EOS) in very low birth weight infants (BW <1.5 kg), 73% (19/26) of sites use umbilical cord blood, and 72% (18/25) use peripheral venipuncture. Two sites routinely collect cord blood for culture in EOS. Only one site applies the concept of differential time-to-positivity to diagnose central-line-associated bloodstream infection.
There is significant practice variation in methods used to obtain blood cultures in level-3 NICUs across Canada. Standardization of blood culture collection practices can provide reliable estimates of the true incidence of neonatal sepsis and help to develop appropriate antimicrobial stewardship strategies.
脓毒症是新生儿死亡和发病的主要原因。血培养是诊断新生儿脓毒症的金标准；然而，目前对于新生儿血培养采集尚无共识性指南，全球新生儿重症监护病房（NICU）的实际操作存在显著差异。
研究加拿大各NICU在评估新生儿脓毒症时采集血培养的现行做法。
向加拿大29家具备为新生儿提供高度专业化护理能力的三级NICU各发送一份包含9个项目的电子调查问卷。
90%（26/29）的机构回复了问卷。65%（17/26）的机构有针对新生儿脓毒症调查的血培养采集指南。48%（12/25）的机构常规每个培养瓶的采血目标量为1.0 mL。在晚发性脓毒症（LOS）中，58%（15/26）的机构处理1个需氧培养瓶，而有4个机构常规添加厌氧培养瓶。在出生体重极低（BW<1.5 kg）的早发性脓毒症（EOS）中，73%（19/26）的机构使用脐带血，72%（18/25）的机构使用外周静脉穿刺。有2个机构在EOS中常规采集脐带血进行培养。只有1个机构应用阳性时间差异的概念来诊断中心静脉导管相关血流感染。
加拿大三级NICU采集血培养的方法存在显著的实际操作差异。血培养采集操作的标准化可以提供新生儿脓毒症真实发病率的可靠估计，并有助于制定适当的抗菌药物管理策略。
